6301 ELLIOTT WAY 2019-09-04 - Laserfiche WebLink

Pl1ELIC WORKS PERMIT LICATION CITY OF EVERETT PERMIT SERVICES EY 3200 CEDAR STREET, EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps@everettwa.gov I https://everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 6'30) E-17/0-ii- frs SITE WORK FOR PROJECT TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ODUPLEX ❑MULTI-FAMILY ❑COMMERCIAL ❑INDUSTRIAL IF APPLICABLE: 0 LAND USE PROJECT#(SEPA,PRE-APP,SS,ETC.) IF APPLICABLE: 0 FRANCHISE/UTILITY COMPANY,ANNUAL BLANKET PERMIT# UTILITY COMPANY'S NAME&JOB#: JOB# DESCRIPTION OF SITE WORK/ RIGHT-OF-WAY WORK FILL IN ALL QUANTITIES OF WOK BELOW,AS APPLICABLE: .ENCE IN ROW Alai" 6 FT IN HEIGHT ❑DRIVEWAY APRON/CURB CUT FT WIDE ,..: r ❑ASPHALT/CONCRETE PAVING SF LE ": _k.0 W7IE gr ❑RETAINING WALL/ROCKERY IN RIGHT-OF-WAY LF OCTig ❑RETAINING WALL/ROCKERY OVER 4FT IN HEIGHT FT TOTAL HEIC T �� 2 ❑CLEARING/GRADING/FILL/EXCAVATE CY CITY OF EVERETT o CUT/BORE IN PAVEMENT(PARALLEL) LF Permit Services ❑CUT/BORE IN PAVEMENT(NON-PARALLEL) LF ❑POLE WORK/AERIAL/OVERLASH LF ADDITIONAL DESCRIPTION(AS NEEDED): CONTACT/ INFORMATION OWNER/APPLICANT NAME: ywgy t", x OWNER/APP. MAILING ADDRESS. 0-EET 60` �''s�.�"7/n U ,////��,, CITY ,— 1:Mfrs STATErieZIP OWNER/APP. PHONE: eT 677-49/i OWNER/APP.EMAIL: CONTRACTOR NAME: yy, CONTRACTOR ADDRESS: -111-41a-e CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): if--/9-72-e_ EVERETT BUSINESS LICENSE#GREQUIRED): PRIMARY CONTACT: 0 OWNER /APPLICANT 0 CONTRACTOR 0 OTHER(Architect,Engineer, Etc.) CONTACT N E: CONTACT PHONE: CONTACT EMAIL: ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to this permit must comply with current federal,state,and local law. The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the Building Official before being authorized under any circumstance.I am the owner,or I am authorized by the owner of this property to perform the work for which application is made,and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only / 411, PERMIT# -_ /0///i PW (J/0 - °se) irner/Authorized /0 - ° ner/Authorized Agent Signature Date (Revised 1/52017)